Opinions differ on lessons from SARS

HEALTH CARE With the outbreak now over, experts are assessing what can be done to make sure the nation can handle similar emergencies in the future

By Melody Chen / STAFF REPORTER

Students from the Hung-ai Center perform at the Howard Plaza Hotel yesterday during an event to celebrate medical workers in Taipei City and their efforts at fighting SARS.

PHOTO: SEAN CHAO, TAIPEI TIMES

As Taiwan celebrates its removal from the WHO's list of SARS-affected areas, hospitals and government health agencies have begun reviewing the weaknesses of the healthcare system that were exposed by the epidemic.

While government health agencies urged hospitals to participate more in public-health networks, hospitals said government experts had not done enough to contain the disease.

During the outbreak, local health bureaus in counties and cities had trouble finding hospital beds for SARS patients, said Mary Huang (黃美娜), director of Taichung County Government's health bureau.

"Hospitals were afraid of admitting SARS cases because they might cause a sharp drop in the number of other patients," Huang said.

It was only after the Bureau of National Health Insurance and its local branches intervened that heath bureaus finally managed to send SARS cases to hospitals.

"Hospitals should care more about public-health issues. It is important for doctors to go out of their hospitals to join activities in the outside world," Huang said.

To prepare for a possible return of the disease, Huang said that strengthening cooperation between hospitals and government health agencies would be key.

Chang Chin-un (張錦文), president of the Taiwan Hospital Association, disagreed, saying the job of doctors was to see patients and that public-health issues should be left to government experts.

At the end of May, the association called for the Department of Health to speed up the pace of establishing SARS hospitals to prevent people with the disease from transmitting it to other hospitals.

Chang said his association made the call to ensure other patients would be treated in a safe medical environment.

"To tell to the truth, many patients died because they didn't dare go to hospitals to have their diseases treated," Chang said.

In response to Huang's call for doctors to get more involved in public-health work, Chang questioned the role of public-health experts in dealing with the outbreak.

He said the government experts ought to have investigated how SARS spread in cities and counties.

"More than 20 universities in Taiwan have departments of public health. Our health authorities should assign these universities to conduct field investigations into SARS in the regions where they are located," Chang said.

He suggested that these departments form student investigation teams led by professors to study issues such as how local health agencies contained the disease or how the disease was transmitted.

Another weakness in the healthcare system is the way the national health insurance program's payment system affects doctors' sovereignty in deciding how to treat patients, Huang said.

"Doctors can't freely decide to give patients all the examinations or treatment they need because the health insurance program does not cover all examinations and treatment," Huang said.

According to Chang and Lin Meau-tong (林淼塘), a board member of the Republic of China Medical Association, the national health insurance program has severely distorted the nation's healthcare system since its implementation eight years ago.

"Before the implementation of the national health insurance program, top medical students all chose to specialize in external medicine because they could study surgery -- a higher medical skill," Chang said.